Provider Demographics
NPI:1093197261
Name:GERDEMAN, STEPHANIE RENEE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:GERDEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:COUTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FL
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 VILLAGE SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1783
Practice Address - Country:US
Practice Address - Phone:419-872-3213
Practice Address - Fax:419-872-9549
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17576163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse